THE EFFECTS OF AGING ON SLEEP

What You Can Do About It

by Kate Bender

Sleep plays a critical role in good health. Despite being well established that most adults need at least seven hours of sleep each night, the Centers for Disease Control and Prevention reports that more than one third of all American adults get less than that. As we age, our need for sleep does not decrease. Yet, the challenges to get a good night’s sleep increase. Normal age-related sleep changes include increased snoring, more nocturnal awakenings, and sleepwake phase advancement by which you wake up and fall asleep earlier than you did when younger. Increased snoring is primarily related to weakening of the muscles in the tongue and neck. It can be a sign of sleep apnea (pauses in breathing during sleep). If you wake up feeling unrested or experience daytime drowsiness, talk to your medical provider about getting tested for sleep apnea with a sleep study. This can be conducted at home or in a sleep lab. Untreated sleep apnea increases risk for motor vehicle accidents (due to drowsy driving), cognitive deficits, moodiness and irritability, depression, sexual dysfunction, high blood pressure, heart disease, stroke, heart failure, obesity, type-2 diabetes, nonalcoholic fatty liver disease, and maybe even cancer. If you are avoiding a sleep study because you believe you will be told to manage apnea with a CPAP machine, don’t put it off. CPAP (Continuous Positive Airway Pressure) is the gold standard of treatment for obstructive sleep apnea, but it is not the only intervention. When left untreated, the harm to your body from sleep apnea can be severe. If concerned, ask your medical provider about a sleep study. If the snoring of a bedmate leaves you unrested, or sleep apnea has been ruled out through a sleep study, consider lifestyle modifications. Weight loss is recommended for a body mass index (BMI) over 30. Losing weight can reduce snoring and other health risks, too. Other changes, such as sleeping with your head elevated, treatment for nasal congestion, and avoiding sleeping on your back to reduce the amount or volume of snoring. Surgical options include removing the tonsils. Consult an otolaryngologist (Ear, Nose, Throat or ENT doctor) to see if other treatments are right for you or your bedmate. Waking up during the night is common with aging. Pain, menopause or an enlarged prostate may disturb sleep. Chronic pain can be related to arthritis, back issues or nerve conditions such as neuropathy. Getting calm and comfortable for sleep can be difficult when you are in pain. Addressing the root cause of the pain is the most effective approach. Once the source

is identified, it can be more specifically addressed. It may sound counterintuitive, but chronic pain often responds well to regular movement. When you sit around for long periods of time, your body stiffens. And stiffness equals pain. Motion is lubricant for joints, muscles and connective tissues. A regular stretching routine or low-intensity exercise, such as walking or yoga, can have a significant, positive impact on body aches and pains. If an over-the-counter pain medication is appropriate for you, choose a non-PM formula. Most medications with “PM” in the name contain diphenhydramine (or Benadryl.) The American Academy of Sleep Medicine recommends against using diphenhydramine for chronic insomnia. (Always tell your medical providers about all the prescription and over-the-counter medications you take.) Lastly, how old is your mattress and/or pillow? If it is hard to answer that question, it is likely time for a new one. If your mattress and pillow are beyond their lifespan, it is not adequately supporting your body while you sleep; this can cause pain. Some causes for nocturnal awakenings are gender specific. For women, menopausal changes can interfere with sleep. Eighty percent of women experience hot flashes, the most common of menopause symptoms. Decreasing estrogen levels cause the body to initiate its cooling mechanisms at much lower temperature changes, triggering a hot flash. More common at night, hot flashes are often associated with interrupted sleep. Sleeping with a fan or in a cool environment can help reduce hot flashes. Losing weight, giving up tobacco and increasing physical activity can also help. For men, benign prostatic hyperplasia (BPH), or an enlarged prostate, is a major driver of sleep disturbances. BPH is a common chronic condition starting in the early 40s and becoming even more common with advancing age. Because the enlarged prostate inhibits complete emptying of the bladder, the holding capacity is decreased. Therefore, you need to pee more frequently. Increased exercise and weight loss can reduce BPH and the associated lower urinary tract symptoms. Avoiding excessive caffeine or increasing citrus juice intake can lower BPH risk. Another natural part of aging is a change or disturbance of circadian rhythms that can advance the sleep-wake phase, making you sleepy earlier in the evening and waking earlier in the morning. Furthermore, older adults are often retired with less of a fixed schedule. This sometimes leads to poor sleep hygiene behaviors that can throw off your circadian rhythms.

What is sleep hygiene? It is the term applied to healthy habits that promote good sleep. Good sleep hygiene is important at all ages. With increased sleep challenges that come with advancing age, it becomes more essential. Here are the highlights:

n Keep a regular schedule. Have a set bedtime and wake-up time. Avoid daytime napping, especially long or late-in-the-day naps. n Avoid substances that impact sleep. Limit caffeine intake after lunchtime. Avoid alcohol close to bedtime. While alcohol is initially sedating, it also inhibits restful sleep. Avoid nicotine as it is a stimulant. n Head to bed with a satisfied stomach. Late-night snacks or large meals just prior to bed as well as going to bed hungry will negatively impact your sleep. n Exercise during the day. Try to avoid vigorous exercise within two hours of bedtime. n Create a quiet, dark and soothing sleep environment. Take time before bed to calm your body and mind. Limiting light exposure is important for circadian rhythms; this includes light from TVs, tablets and phones.

Sweet dreams!

Kate Bender, APRN, an adult nurse practitioner at Fernwood Holistic Health in Westbrook, Connecticut, supports and empowers patients to find solutions that improve their physical and emotional health. Connect at 860-661-5824 or info@fernwoodholistichealth.com. Coming Next Month